Provider Demographics
NPI:1285076141
Name:CORTEZ, DANIEL ALBERTO (RD/LD)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ALBERTO
Last Name:CORTEZ
Suffix:
Gender:M
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4319 ADDISON CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-4184
Mailing Address - Country:US
Mailing Address - Phone:956-342-0747
Mailing Address - Fax:151-251-9885
Practice Address - Street 1:4319 ADDISON CT
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-4184
Practice Address - Country:US
Practice Address - Phone:956-342-0747
Practice Address - Fax:151-251-9885
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-20
Last Update Date:2013-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86009996133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1285076141Medicaid
TX1285076141Medicare NSC